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MedicalMarijuana.ca is very pleased to announce the opening of the Greenleaf Medical Clinic! It is located on the outskirts of Vancouver, British Columbia. This clinic can see patients in person and also from the comfort of their own home, anywhere in Canada through VSee. If you are not familiar with VSee, thats ok, we will help with that too. If you are just down the street or in Newfoundland you will need to complete the following application to see our physician. We thank you for taking the time to apply. You will be hearing from us shortly!

Please fill out the following form that will give us the information we need to help you, whatever stage of the process you are at.

Personal Information

First Name

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Last Name

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Province

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Phone Number

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Alternate Phone

Email

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Email Confirm

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Yes, I would like to be notified of news at MedicalMarijuana.ca and/or greenleafmc.ca

Gender

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Age Range

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Are you currently receiving financial assistance?

Please let us know if you were referred by one or more of the following:A www.MedicalMarijuana.ca PatientCanadian AIDS SocietyCanadian Cancer SocietyCanadian Paraplegic AssociationCompassion ClubEpilepsy CanadaFamily MemberFriendInternet ResearchMagazine/Journal/NewspaperMS Society of CanadaMy DoctorThe Arthritis SocietyOther

Notes

Notes

To better assist you, please tell us as much as you feel comfortable with in regards to your situation and condition(s). Please be specific in regards to diagnosis, seeing specialists, medical treatments you have received like X-rays and MRIs and what prescriptions you have been on.

Medicine Information

Are you currently using marijuana?

Terms and Conditions

All are Required.

I have read, understood and agree to the privacy policy.I confirm I am a Canadian citizen, permanent resident or an aboriginal, over the age of 18 and currently reside in Canada.I give consent to share appropriate portions of my application with MedicalMarijuana.ca's trusted doctors and growers as is needed to process my application.I agree to and understand the fees associated with the Greenleaf Medical Clinic.